One in seven mothers who just gave birth may be suffering form postpartum depression, according to a new study published online in JAMA Psychiatry on March 13.
Postpartum depression is moderate to severe depression that occurs after a woman gives birth, usually within the three months from delivery. The exact causes are unknown, but experts suspect that changes in hormone levels during and after pregnancy may play a role.
Risk factors for postpartum depression include being under the age of 20; alcohol, drug or tobacco abuse; having an unplanned pregnancy; having mixed feelings about the pregnancy; a history of depression, bipolar disorder or anxiety disorders; having a close family member with depression; or anxiety or experiencing a stressful event during the pregnancy or delivery. A bad relationship with your significant other, being single while pregnant, money or housing problems and poor familial support can also increase the chances of developing the disorder.
"The vast majority of postpartum women with depression are not identified or treated even though they are at higher risk for psychiatric disorders," lead author Dr. Katherine Wisner, director of Northwestern University's Asher Centre for Research and Treatment of Depression in Chicago, told the Telegraph. "A lot of women do not understand what is happening to them. They think they're just stressed or they believe it is how having a baby is supposed to feel."
The study evaluated 10,000 women who had given birth at an obstetrical hospital in Pittsburgh for depression, through a telephone interview four to six weeks after labor.
"We asked them whether they had been able to laugh and see the funny side of things... (as well as their) ability to look forward with enjoyment to things, whether or not they're blaming themselves necessarily when things go wrong, feeling anxious or worried for no good reason, being scared or panicky for no good reason," study investigator Dorothy Sit, a University of Pittsburgh psychiatrist, told NPR.
About 1,400 women -- 14 percent -- were found to have positive signs for depression. The rates were similar to what was seen in other studies. Women who tested positive tended to be younger, African-American, publically insured, single and less well-educated.
The researchers then completed home visits with 826 of the people who tested positive and phone interviews with an additional 147 of them.
For the women with depression, 40.1 percent felt symptoms postpartum, 33.4 had them during pregnancy and 26.5 experienced them before getting pregnant. Most of the women had unipolar depressive disorders (68.5 percent), and 66.7 percent had comorbid anxiety disorders (meaning more than one disorders in addition to anxiety). Surprisingly, 22.6 percent had bipolar disorder, and 19.3 percent had thoughts of self harm or suicidal thoughts.
Sit believes that all pregnant women and new moms should be screened for depression ideally at home so they can get diagnosed and received treatment sooner, but even a clinical questionnaire may help. Lead author Dr. Katherine L. Wisner, a professor at Northwestern Medicine in Chicago, agreed. She added to UPI that suicide makes up 20 percent of postpartum deaths, and is the second most common cause of death in postpartum women.
"Most of these women would not have been screened and therefore would not have been identified as seriously at risk," Wisner explained to UPI. "We believe screening will save lives."
Dr. Rebecca Starck, director of the obstetrics unit at the Cleveland Clinic in Cleveland, Ohio, said to NPR that they routinely screen women for depression during the third trimester of their pregnancy. She was not involved in the study.
She added that she tells mothers that it is normal to have moodswings and cry at strange times, but other behaviors are a warning sign. Screening can help get those women help. However, many women are embarrassed of the stigma of being depressed, so they forgo treatment.
"But if you feel like you can't sleep ... or if you feel like you're in a deep dark hole and you don't see a light at the end of the tunnel, you may, in fact, be somebody who needs to go on medication or have some counseling," she explained.
June Horowitz, a postpartum depression researcher and professor of nursing at Boston College who was not involved in the study, said to the Pittsburgh Post-Gazette that the findings were paramount information.
"I think we still in this country really do not recognize mental health issues, we still have that Puritan, pull-yourself-up-by-your-bootstraps, be-tough attitude," she said.
"It should be the gold standard that everyone gets screened for postpartum depression," she added.
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